Common steps and sub-activities

Buteyko Breathing system

The Buteyko Breathing system is a form of therapy that uses controlled breathing  to treat asthma and other respiratory problems.  The method uses various forms of monitored controlled breathing to retrain the breathing pattern of people who are suffering from respiratory and other problems. 

This method is based on the assumption that numerous medical conditions, including asthma, are caused by hyperventilation – ‘wrong’ breathing - either a chronically increased respiratory rate or deeper breathing or some other dangerous combination.

The following describes hyperventilation……………..

The Respiratory system in applied psychophysiologyDr Richard Gevirtz and Dr Mark Schwartz

The job of the respiratory system is to facilitate the exchange of vital gases in the body.  Oxygen is taken in through the trachea or windpipe and pumped through a vast system of increasingly smaller tubes, which have the characteristic of letting some gases through to the blood and in turn taking waste gases (mostly carbon dioxide, or CO2) back to be exhaled. This process is called "gas exchange." This takes place in the lungs.

CO2 plays an important role in how the haemoglobin releases the oxygen. As blood pH changes, based on breathing changes, the haemoglobin molecule releases its oxygen cargo. If too little CO2 is present, the oxygen is ‘over-bound’ to the haemoglobin and not available to fuel body organ tissue. 

To understand this process more clearly, consider the analogy of a milk truck trying to deliver individual bottles of milk to local stores. The oxygen is represented by the milk; the haemoglobin is the milk truck, and the store is the body tissue needing fuel to function properly. The dairy (the heart-lung system) loads the truck up with an excess of milk bottles, and the truck sets off on its appointed rounds. Once the truck arrives at the store, the cargo door must be opened wide enough to make an adequate delivery. Since CO2 controls the release of the oxygen from the haemoglobin, it would be seen as regulating the width of the door, so that in the scheduled time enough milk can be dropped off at the store. Not enough CO2 means an inadequate delivery and shortages.

In physiology, this oxygen dissociation function is known as Bohr's Law. It says that the oxygen can be "over-bound" to the haemoglobin, creating hypoxia or lack of oxygen, which can produce symptoms such as lightheadedness, heart pounding, cold hands, nervous emotional states, or even mental "fog."

Normal cortical blood flow can be interrupted by only a few minutes of Hyperventilation.

HV means that the lungs are releasing [into the atmosphere] too much CO2, because breath rate and/or tidal volume (the amount of air that is breathed out) exceed the level needed for the present conditions. This is often referred to as "over-breathing," or hypocapnia. …. the shift in blood flow…….. can be dramatic.

In fact, HV is used as an emergency room procedure to reduce bleeding in the brain.

It is known that hyperventilation can lead to low carbon dioxide levels in the blood (or hypocapnea), which can subsequently lead to disturbances of the acid-base balance in the blood and lower tissue oxygen levels. But Buteyko also noticed that long term chronic hyperventilation has additional effects - widespread spasms of the muscle in the airways (bronchospasm), disturbance of cell energy production via the Krebs cycle, as well as disturbance of numerous homeostatic chemical reactions.   The chart below shows the symptoms of hyperventilation.

Now you may be saying at this point – well surely this is exactly what we want – hypoxia produces spiritual experience, but we need to remember here that wrong breathing on a regular basis leads to all sorts of problems.

Done for too long, hyperventilation can do permanent damage.  Hypoxia can cause brain damage and one function to go might be memory and reason!  And it can cause heart problems, back problems, kidney problems, hearing problems, problems with balance and so on which ultimately are caused by damage to the brain and the organs which control these functions.

 So Buteyko was saying that a large number of medical problems could be caused [not are caused, could be caused] by people not breathing correctly, which may sound barmy because breathing is supposed to be autonomic, but what he found is that sometimes people develop patterns of breathing that are anything but autonomic without realising it.  Anxiety, depression, underlying fear and a whole host of emotions may subconsciously cause them to hyperventilate on a permanent basis.

By "retraining" the body's breathing pattern to correct for this chronic hyperventilation, Buteyko believed one could treat and cure the body of these additional medical problems.

At the core of the Buteyko method is a series of reduced-breathing exercises that focus on nasal-breathing, breath-holding and relaxation.  This is combined with advice on nutrition, exercise and medication use.  It is thus a package of techniques not just a simple technique.

At which point you are entitled to ask – well if it actually seeks to cure hyperventilation and controlled breathing as a mechanism works via hyperventilation how can Buteyko be any use for spiritual experience and the answer is that it promotes total relaxation.

In effect, via the use of controlled breathing techniques, the Buteyko method promotes total relaxation, so it can give you a mild and pleasant form of spiritual experience via the total relaxation as opposed to the controlled breathing.

Background

The Buteyko method was originally developed in the 1950s by the Ukrainian physiologist Konstantin Buteyko. Buteyko died in 2003, but his method continues to be used, not just in Russia and the Ukraine, but in Australia, New Zealand, Britain and the United States, where it has received increasing exposure.

The first official study into the effectiveness of the Buteyko Method on asthma was undertaken in 1968 at the Leningrad Institute of Pulmonology. The second, held at the First Moscow Institute of Pediatric Diseases in April 1980, eventually led to the head of the ministry of health to issue an order (No 591) for the implementation of the Buteyko method in the treatment of bronchial asthma.

Needless to say, the established medical community – more particularly that in America who rely on drugs and are closely aligned with drug companies, tend to dismiss Buteyko’s work and findings, however, there is a sizable body of evidence that tends to support his findings [see below].  I have dismissed the American studies and searched for more balanced research that is not ‘loaded’ by preconceptions and bias and what comes out is well represented by the following two papers.

Expert Rev Respir Med 2011 Dec;5(6):789-807.  Systematic review of the effectiveness of breathing retraining in asthma management. - Burgess J, Ekanayake B, Lowe A, Dunt D, Thien F, Dharmage SC;   Centre for Molecular, Environmental, Analytic and Genetic Epidemiology, Melbourne School of Population Health, The University of Melbourne, Victoria 3010, Australia.

In asthma management, complementary and alternative medicine is enjoying a growing popularity worldwide. This review synthesizes the literature on complementary and alternative medicine techniques that utilize breathing retraining as their primary component and compares evidence from controlled trials with before-and-after trials.

Medline, PubMed, Cumulative Index to Nursing and Allied Health Literature and the Cochrane Library electronic databases were searched. Reference lists of all publications were manually checked to identify studies not found through electronic searching. The selection criteria were met by 41 articles.

Most randomized controlled trials (RCTs) of the Buteyko breathing technique demonstrated a significant decrease in ?(2)-agonist use while several found improvement in quality of life or decrease in inhaled corticosteroid use. Although few in number, RCTs of respiratory muscle training found a significant reduction in bronchodilator medication use. Where meta-analyses could be done, they provided evidence of benefit from yoga, Buteyko breathing technique and physiotherapist-led breathing training in improving asthma-related quality of life.

However, considerable heterogeneity was noted in some RCTs of yoga. It is reasonable for clinicians to offer qualified support to patients with asthma undertaking these breathing retraining techniques.

The paper above shows that quite a number of trials have been done on the Buteyko technique up to 2011.  When the paper below was written, the number of trials was less, but what it shows is that many who undertook the earlier trials did not appreciate the totality of the Buteyko approach – that the system is not just about breath holding, but about a combination of what are in effect techniques to obtain relaxation and thus healing energy.

Complement Ther Med  2005 Mar;13(1):41-6. Epub 2005 Apr 18;  The Buteyko breathing technique for asthma: a review. - Bruton A, Lewith GT;  School of Health Professions and Rehabilitation Sciences, University of Southampton, Highfield, Southampton SO17 1BJ, UK.

Breathing exercises and breathing retraining are often used in the management of asthma. One specific form of breathing therapy, known as the Buteyko breathing technique (BBT) has received considerable attention, but there is a paucity of rigorous research evidence to support its recommendation for asthma patients. There are only four published clinical trials and two conference abstracts evaluating BBT. Although all have reported improvements in one or more outcome measures, results have not been consistent.

This article provides the background to the BBT, reviews the available evidence for its use and examines the physiological hypothesis claimed to underpin it.

In common with other therapies, BBT is not a standardised treatment modality. The BBT 'package' is complex, as it also includes advice and education about medication use, nutrition and exercise, and general relaxation. This makes it difficult, and possibly inappropriate, to attempt to tease out a single mechanism.

Buteyko's theory relating to carbon dioxide levels and airway calibre is an attractive one, and has some basis in evidence from experimental studies. However, it is not known whether altering breathing patterns can raise carbon dioxide levels significantly, and there is currently insufficient evidence to confirm that this is the mechanism behind any effect that BBT may exert. Further research is necessary to establish unequivocally whether BBT is effective, and if so, how it may work.
PMID: 15907677

The American view appears to be that drugs are the answer [to everything!], however, the rest of the world seems more reflective.  The British Thoracic Society, for example, stated the Buteyko method "may be considered to help patients control the symptoms of asthma".  In effect, they are open to consider it as an option.

As we will see if you turn to the section on asthma it is mis-diagnosed on a very frequent basis, with people [particularly children] being given inhalers for any number of conditions that are unrelated to asthma – including food allergies such as dairy intolerances, smoke and cigarette intolerance and wheat intolerances, additive intolerances and intolerance for genetically modified food stuffs.  Asthma inhalers have also been prescribed incorrectly for those with heart problems and anxiety and depression, as such the reason why the Buteyko method can produce such different effects in so called asthma sufferers is because the patients have been misdiagnosed in the first place.

But in the following sentence we may see the real cause why America resists this technique - money.

An expert guideline by the Global Initiative for Asthma noted that results from one study suggested that improvement in symptoms by breathing exercises may be due to causes other than changes in the underlying physiology of the disease, such as relaxation, voluntary reduction in medication use and increased participation of the patient in their own care. This result suggests patients who experience anxiety or who overuse their rescue inhalers in particular may benefit from any breathing techniques as an adjunct to conventional treatments, though the cost of using these techniques may be prohibitive

Rather interestingly, in the UK and New Zealand at least, these techniques are looked on as potential money savers, not money losers. Perhaps the money being lost is that of the drug companies in the USA.

Nurs Stand. 2006 Apr 12-18;20(31):20-1 - Russian revelation - Millar B.

Jill McGowan was convinced that a programme of breathing retraining--the Buteyko Method - could reduce the medication needs of people with asthma. So she gave up her nursing job and sold her house and car to finance research.

Training requires five 90-minute sessions. The 30-minute exercise programme has to be repeated six times a day initially. Introduction of the method to the NHS could have a major impact on asthma management with potentially huge savings on cost.  PMID: 16629103

N Z Med J. 2003 Dec 12;116(1187):U710.   Buteyko Breathing Technique for asthma: an effective intervention - McHugh P, Aitcheson F, Duncan B, Houghton F;  Emergency Department, Gisborne Hospital, Gisborne, New Zealand.

AIM
To assess the impact of the Buteyko Breathing Technique (BBT) on medication use in asthma.

METHODS
A blinded randomised controlled trial comparing BBT with control was conducted in 38 people with asthma aged between 18 and 70. Participants were followed for six months following the intervention. Medication use and indices of ventilatory function were recorded.

RESULTS
No significant change in FEV1 (forced expiratory volume in one second) was recorded in either group. The BBT group exhibited a reduction in inhaled steroid use of 50% and beta2-agonist use of 85% at six months from baseline. In the control group inhaled steroid use was unchanged and beta2-agonist use was reduced by 37% from baseline. Investigator contact between the two groups was equal. There were no adverse events recorded in either group.

CONCLUSIONS
BBT is a safe and efficacious asthma management technique. BBT has clinical and potential pharmaco-economic benefits that merit further study.

References

Buteyko Clinic Method; (with DVD and CD) the Complete Instruction to Reverse Asthma, Rhinitis and Snoring Permanently: Suitable for Children and All Adults. by Patrick McKeown

Close Your Mouth: Buteyko Breathing Clinic self help manual by Patrick McKeown

Doctor Buteyko's Discovery by Sergey Altukhov, Fiona Paterson, Marjorie Farquharson and Denise Steele

Buteyko Breathing Method (VHS Tape)

Self Help Asthma - The Buteyko Method, DVD Pack: The Buteyko Method - An Effective Way to Relieve and Control Asthma Symptoms by Dr James Oliver and Janet Brindley

Living without Asthma: The Buteyko Method  by Andrey Novozhilov, Victor Lunn-Rockliffe and Thomas Kirschner

http://www.buteykobreathing.org/  - The Buteyko Breathing Association was formed in 1999 by the first group of UK health professionals trained to teach BBT. It is a non profit making organisation of teachers specialising in the assessment and treatment of adults and children with breathing problems using the Buteyko breathing techniques (BBT).
The organisation started as a group of ten enthusiastic teachers. Over 150 health professionals have now been trained to teach BBT in the UK, and membership has grown steadily over the years.  There are now BBA teachers around the world.

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